高剂量替莫唑胺治疗在胶质母细胞瘤中应用的网状Meta分析
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摘要
目的探讨高剂量替莫唑胺治疗方案与标准替莫唑胺治疗方案在新诊断胶质母细胞瘤患者中的疗效。方法分别检索Pubmed,Cochrane,Embase、知网,万方,维普,CBM各数据库;对纳入文章进行质量评估,数据提取后采用Stata13.0进行网状Meta分析。结果分析揭示:替莫唑胺治疗方案的有效性排序从高到低依次是高剂量治疗方案、早期治疗方案、规律治疗方案、标准治疗方案、放疗和放疗后辅助替莫唑胺治疗方案。副作用方面,分析揭示:最常见的血液学不良反应包括白细胞、嗜中性粒细胞、淋巴细胞和血小板减少症,贫血;各自发生率在不同治疗组差异无统计学意义。结论在新诊断的胶质母细胞瘤患者中,高剂量替莫唑胺治疗方案的干预效果优于标准替莫唑胺治疗方案,且不同类型的血液毒性反应发生率在不同干预组差异无统计学意义。
Objective To analyze the intervention effect of the dose-dense schemes of temozolomide on the newly diagnosed glioblastoma compared with the standard schemes. Methods The Pubmed,Cochrane,Em-base,CNKI,CBM,Wanfang,VIP databases were used for the retrievals on the intervention effect. The quality ofincluded papers was assessed to extract network Meta-analysis data with using the statistical software Stata 13.0.Results The treatment plans were ranked according to the intervention effect from the best to the worst as follows:the dose-dense,the early,the metronomic,the standard,the RT and post-RT adjuvant temozolomide. The mostcommon adverse effects in hematotoxicity were neutropenia,leucopenia,lymphopenia,thrombocytopenia and ane-mia. Between the different temozolomide therapeutic regimens,there was no significant difference. Conclusion The intervention effect of the dose-dense schemes with temozolomide is better than the standard therapy. It alsorevealed that,the hematoxicity in the different temozolomide schemes is not significantly different.
Objective To analyze the intervention effect of the dose-dense schemes of temozolomide on the newly diagnosed glioblastoma compared with the standard schemes. Methods The Pubmed,Cochrane,Em-base,CNKI,CBM,Wanfang,VIP databases were used for the retrievals on the intervention effect. The quality ofincluded papers was assessed to extract network Meta-analysis data with using the statistical software Stata 13.0.Results The treatment plans were ranked according to the intervention effect from the best to the worst as follows:the dose-dense,the early,the metronomic,the standard,the RT and post-RT adjuvant temozolomide. The mostcommon adverse effects in hematotoxicity were neutropenia,leucopenia,lymphopenia,thrombocytopenia and ane-mia. Between the different temozolomide therapeutic regimens,there was no significant difference. Conclusion The intervention effect of the dose-dense schemes with temozolomide is better than the standard therapy. It alsorevealed that,the hematoxicity in the different temozolomide schemes is not significantly different.
引文
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[12]赵鹤翔,高利民,冯文,等.替莫唑胺联合放疗治疗多形性胶质母细胞瘤的临床疗效观察[J].海南医学,2012,23(24):1-4.
[13]PARK C K,LEE S H,KIM T M,et al.The value of temozolo-mide in combination with radiotherapy during standard treat-ment for newly diagnosed glioblastoma[J].J Neurooncol,2013,112(2):277-283.
[14]MAO Y,YAO Y,ZHANG L W,et al.Does early postsurgicaltemozolomide plus concomitant radiochemotherapy regimenhave any benefit in newly-diagnosed glioblastoma patients?Amulti-center,randomized,parallel,open-label,phaseⅡclini-cal trial[J].Chin Med J(Engl),2015,128(20):2751-2758.
[15]李晓兴,王之敏.替莫唑胺治疗神经胶质瘤的研究进展[J].实用医学杂志,2012,28(1):27-29.
[16]WICK W,PLATTEN M,WELLER M.New(alternative)temo-zolomide regimens for the treatment of glioma[J].Neuro On-col,2009,11(1):69-79.
[2]王亚华,应雪,张春春,等.替莫唑胺联合姜黄素对C6胶质瘤细胞凋亡的作用[J].实用医学杂志,2016,32(10):1564-1567.
[3]COHEN M H,JOHNSON J R,PAZDUR R.Food and DrugAdministration Drug approval summary:temozolomide plus ra-diation therapy for the treatment of newly diagnosed glioblasto-ma multiforme[J].Clin Cancer Res,2005,11(19):6767-6771.
[4]ARMSTRONG T S,WEFEL J S,WANG M,et al.Net clinical benefit analysis of radiation therapy oncology group 0525:aphase III trial comparing conventional adjuvant temozolomidewith dose-intensive temozolomide in patients with newly diag-nosed glioblastoma[J].J Clin Oncol,2013,31(32):4076-4084.
[5]WICK A,PLATTEN M,WICK W,et al.Efficacy and tolera-bility of temozolomide in an alternating weekly regimen in pa-tients with recurrent glioma[J].J Clin Oncol,2007,25(22):3357-3361.
[6]GILBERT M R,WANG M,ALDAPE K D,et al.Dose-densetemozolomide for newly diagnosed glioblastoma:a randomizedphase III clinical trial[J].J Clin Oncol,2013,31(32):4085-4091.
[7]CATALA-LOPEZ F,MOCHER D,HUTTON B,et al.Networkmeta-analysis for comparing treatment effects of multiple inter-ventions:an introduction[J].Rheumatol Int,2014,34(11):1489-1496.
[8]ATHANASSIOU H,VERIGOS C,SARIS G,et al.Random-ized phase II study of temozolomide and radiotherapy comparedwith radiotherapy alone in newly diagnosed glioblastoma multi-forme[J].J Clin Oncol,2005,23(10):2372-2377.
[9]STUPP R,MASON W P,WELLER M,et al.Radiotherapyplus concomitant and adjuvant temozolomide for glioblastoma[J].N Engl J Med,2005,352(10):987-996.
[10]CLARKE J L,ABREY L E,SUL J,et al.Randomized phase ii trial of chemoradiotherapy followed by either dose-dense ormetronomic temozolomide for newly diagnosed glioblastoma[J].J Clin Oncol,2009,27(23):3861-3867.
[11]周卫兵,汪洁,张莹莹,等.胶质母细胞瘤术后同步放化疗临床疗效观察[J].中国现代医学杂志,2010,20(8):1203-1206.
[12]赵鹤翔,高利民,冯文,等.替莫唑胺联合放疗治疗多形性胶质母细胞瘤的临床疗效观察[J].海南医学,2012,23(24):1-4.
[13]PARK C K,LEE S H,KIM T M,et al.The value of temozolo-mide in combination with radiotherapy during standard treat-ment for newly diagnosed glioblastoma[J].J Neurooncol,2013,112(2):277-283.
[14]MAO Y,YAO Y,ZHANG L W,et al.Does early postsurgicaltemozolomide plus concomitant radiochemotherapy regimenhave any benefit in newly-diagnosed glioblastoma patients?Amulti-center,randomized,parallel,open-label,phaseⅡclini-cal trial[J].Chin Med J(Engl),2015,128(20):2751-2758.
[15]李晓兴,王之敏.替莫唑胺治疗神经胶质瘤的研究进展[J].实用医学杂志,2012,28(1):27-29.
[16]WICK W,PLATTEN M,WELLER M.New(alternative)temo-zolomide regimens for the treatment of glioma[J].Neuro On-col,2009,11(1):69-79.